L-0984d (Rev. March 23, 2015) DECLARATION OF SERVICE Welfare and Institutions Code, 247247 5350-5372 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name & Address) : Telephone No.: Fax No. (Optional): E - Mail Address (Optional): ATTORNEY FOR (Name): Bar No: FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE Central Justice Center 7 00 Civic Center Dr. West Santa Ana, CA 92701 - 4045 IN THE MAT TER OF: DECLARATION OF SERVICE CASE NUMBER: I, the undersigned, hereby declare that I mailed or hand delivered a copy of the Petition for Reappointment of Conservator and Notice of Hearing as follows: 1. Date: Mailed Hand Delivered to: Orange County Health Care Agency Mental Health Director 405 West 5th Street, Suite 458 Santa Ana, CA 92701 2. Date: Mailed Hand Delivered to: Orange County Public Guardian P.O. Box 11526 Santa Ana, CA 92711 3. Date: Mailed Hand Delivered to: Orange County Public Defender 600 West Santa Ana Blvd., Suite 501 Santa Ana, CA 92701 4. Date: Mailed Hand Delivered to: Conservatee: Address: 5. Date: Mailed Hand Delivered to: Facility: Address: 6. Date: Mailed Hand Delivered to: Other: Address: I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct Date: (TYPE OR PRINT NAME) (SIGNATURE OF CONSERVATOR) American LegalNet, Inc. www.FormsWorkFlow.com